title: Conservative management of postoperative bronchopleural fistulas.
abstract: OBJECTIVE
  A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery.
  
  
  METHODS
  Seventeen patients (15 men and 2 women) with a BPF after a pneumonectomy (n = 2) or a lobectomy (n = 15), seen between 1995 and 2010, were reviewed. Their median age was 50 years (range, 14-75 years). Underlying diseases were malignant (n = 4) and nonmalignant (n = 13).
  
  
  RESULTS
  The mean interval between surgery and fistula development was 20 days (range, 5-270 days). Clinical symptoms leading to a diagnosis of BPF were a persistent air leak (n = 2), a persistent air leak associated with pleural empyema (n = 3), pleural empyema alone (n = 11), and dyspnea (n = 1). Mean fistula size was 3.3 mm (range, 2-9 mm). Treatment consisted of oriented pleural drainage, adequate antibiotic therapy, and endoscopic closure of the fistula with local application of silver nitrate through a flexible bronchoscope (3-15 sessions, 3 times per week). Fistula closure was successful in 16 patients, but failed in 1 patient, who died from acute respiratory distress.
  
  
  CONCLUSIONS
  BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention.
authors.affiliation: Thoracic and Cardiovascular Surgery Department, University Hospital Abderrahmen Mami, Faculty of Medicine of Tunis, University of Tunis El Manar, Ariana, Tunisia.
authors.forename: Mohamed Sadok
authors.initials: MS
authors.lastname: Boudaya
authors.forename: Hanène
authors.initials: H
authors.lastname: Smadhi
authors.forename: Hazem
authors.initials: H
authors.lastname: Zribi
authors.forename: Jalel
authors.initials: J
authors.lastname: Mohamed
authors.forename: Jamel
authors.initials: J
authors.lastname: Ammar
authors.forename: Taher
authors.initials: T
authors.lastname: Mestiri
authors.forename: Tarek
authors.initials: T
authors.lastname: Kilani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D001999:Bronchoscopy / Q000379:methods; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012835:Silver Nitrate / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D012835:Silver Nitrate
keywords: 11; 14; BPF; bronchopleural fistula